Make Insurance Cheap Again: Trump Promises Insurance for All

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

Trump declined to reveal specifics in the telephone interview late Saturday with The Washington Post, but any proposals from the incoming president would almost certainly dominate the Republican effort to overhaul federal health policy as he prepares to work with his party’s congressional majorities.

In addition to his replacement plan for the ACA, also known as Obamacare, Trump said he will target pharmaceutical companies over drug prices. “They’re politically protected, but not anymore,” he said of pharmaceutical companies.

Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details — “lower numbers, much lower deductibles” — he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.).

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

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The government overpays for drugs and devices. The only viable solution is to eliminate insurance all together. Reduce regulatory bloat. Make all health care cash and carry. Promote price competition between providers. Then you have a solution.

Michael, I agree that that is the best way to drive down prices. Also, set up health savings accounts for all so you are saving for medical costs tax free and provide catastrophic health insurance for treatments for catastrophic injuries and diseases.

All across Europe one finds reasonably-priced public health care. The recipe is consistent. 1: Buy drugs in quantity and inexpensively. Don’t offer drugs that are extremely expensive; pharmaceutical companies must make them affordable if they want to be in the market or sell only privately. 2. Being a doctor is supposed to be a calling, not a Wall Street job. Doctors should be well-paid, but not financially elite. 3. Limit legal liability in the healthcare arena.

Tort reform wasn’t mentioned, so it is going to be the centerpiece of reform. I could envision patients signing waivers to reduce their cost of service. “I’ll treat you affordably if you don’t sue me,” sounds as good as negotiating drugs in bulk.

It’s true that the faster-than-inflation rise of healthcare costs matches up with government involvement in healthcare. Allowing employers to deduct the cost of healthcare that they paid for was the beginning of the problem. That hid the cost from consumers, and encouraged less concern about costs. Putting costs back directly on consumers would encourage price-comparisions, something totally lacking today.

The discouraging thing about Trumps comments is that he seems to share one thing with Obama’s plan. The focus is on changing who pays, and how they pay, not on limiting the rise of expenses. So long as expenses continue to rise, and utilization continues to rise, overall costs MUST continue to rise as well. If they focus instead on more efficiency in the system to reduce costs, they might have a chance of reducing costs.

I agree any solution that doesn’t lower health care costs won’t work, but Trump isn’t the obstacle to doing this. He wants to lower costs. It’s congress that’s against lowering costs. There are two many in the house and senate that have been bought by the health care industry.

Also, reigning in the AMA, (which is the most successful labor union in existence) could help increase competition and drive down prices. Reducing the regulations from government and the AMA could be part of the solution in reducing overhead and costs.

I agree it would make things cheaper, but you still have the ethical dilemma of whether or not you should treat people who can’t afford the treatment. Also, what’s to prevent you from being way overcharged in the event of an emergency? You can’t shop around and decide what you’re willing to pay for while having a coronary.

Considering the personal responsibilities involved in one’s health, I can’t see much of a moral dilemma in not treating the typical American land whale. They, and they alone. are responsible for their health.

As for insurance, a high-deductible is all that is needed, with those whose behaviors cause them to be unfit paying higher premiums because of added risks.

Genuine emergencies could be cowered under a catastrophic plan. They are so rare they make up a tiny portion of total health care outlays.

Simply listening to Trump’s wording, makes it abundantly clear that he has been just as captured by the Industry as Obama was before him: Reducing deductibles is exactly, precisely, 100%, the wrong way to go about making health care more efficient. Instead, what you want are very high deductibles, so that the end user sees, and hence can make informed cost/benefit decisions regarding, the cost of all routine and predictable services. While possibly insuring against genuinely unaffordable catastrophic events, like being hit by a bus or getting cancer at 40.

If there was one thing that made Obamacare the single greatest failure in the history of inevitably always and everywhere failing government programmes, it was mandating low deductible plans. The Industry loves it, since their customers are suddenly divorced from taking cost into consideration when deciding what to purchase. Leaving third parties to pick up the tab.

Insurance works as long as it works as insurance: everyone pays in a moderate amount regularly, so that the unfortunate few who faces catastrophies can get them covered. Person A simply sending the bill for a routine doctor visit to to some guys called “tax payers”, has nothing to do with insurance. And everything to do with government robbing Peter to pay Paul, for no other reason that the robbing can be done in silence, with the paying done bombastically on TV. Trump, true to Progressive New Yorker form, is seemingly too dumb to figure that one out as well. Instead, like his predecessor, relying on “experts” in the industry to advice him.

I disagree that low deductibles are the problem. Improperly designed plans, such as mandated obgyn coverages for single men, requiring insurers to accept preexisting conditions without allowing proper pricing for it, charging younger people more and older people less than actuarially correct, equal premiums for men and women when women consume much more health care dollars, and on and on with decisions made in order for it to be politically acceptable.

A little off topic but is there a hospital in the country that hasn’t been on a major building spree?

Does anyone else but me notice the amount of advertising they do? Do hospitals really need to spend that much on marketing? Yes healthcare is expensive but there is an awful lot of waste too. I am tired of hospitals poor mouthing.

Obviously you are young and healthy or you are on Medicare. Your proposal would result in the deaths of hundreds of thousands who forgo things like blood pressure and diabetes medication and it would bankrupt millions more who find themselves hospitalized.

It would take years for the medical system to come to some kind equilibrium again.

But since you’re young and healthy, it will be great for you in the long run. A sudden population drop has historically been great for the survivors.

Well, let’s wait and see. I agree the costs are super high because big pharma is protected and the bureaucracy has added costs to Doctors-forcing them to merge with HMOS. The independent Dr. is getting crushed by paperwork

The dems are partially to blame for getting the ACA recalled without a replacement. They stated they wouldn’t work with Trump on a replacement, so Trump had to recall the ACA to force the dems to work with him on a replacement.

#5. Government will negotiate drug prices? No room for corruption here. #3. Congress has to accept this as their own plans too? So everybody gets a basic plan… Or everybody gets a Cadillac plan? I’m confused already because it’s lining right up to be a single payer system just like ACA’s aim to make insurance providers drop out and force the “gubberment” into adopting a single payer system. Trump care seems to be marketing glitter designed to nest right into the Marxest Obamacare scheme.

Trump is vague and ambiguous. We take more prescription medications per capita than anywhere else in the world. Over prescribing is done by most doctors to limit legal issues. If I don’t prescribe and something happens to my patient ( error on overprescribing is insurance against litigation).

Reduce the number of people between you and the point of service. Insurance, PBM, formulary teams, billing, bloated administration people, and board members who siphon money and provide no value at the point of treatment. Only pay for those you see and the meds you get. Paperwork to be filed by the user of service. There is no need for a diagnostic service to be doing the ICD9 bullshit which is in need of revamping anyway. Pay at point of service then deal with your own coverage.
Result:: less wait times by doctor and pharmacy, better outcomes, the person who sees their doctor 7 times a month will be less likely to do so.

Let’s also hope for a tax on fast food and sugar drinks, should be a sin tax here. High Sugar consumption will be viewed as dangers as smoking in the future of our most sedentary society.

Although I am more of a libertarian, the only solution is a single payer system,ie national healthcare. By any parameter our healthcare system is a fail. We have the most expensive per capita costs in the world, averaging about 60% more, and below average health outcomes. If you compare us with the often maligned Canadian system we fail. Again higher per capital costs, worse health outcomes/ratings and on top of it the canadians have a higher patient satisfaction rate. Its not perfect by any means. We should do what the Japanese do, reverse engineer a plan. Take the good parts and fix the bad parts and come up with the best. The problem is we have a corrupt legislative branch who will only do whats best for them and not the country.

I guess it would be more aptly described as what function the government should preform. not convenience. Do we need the military, public schools, police, etc etc. I believe that every citizen in our country should have the right to healthcare. There is an interesting book that address’s this called The Healing of America by TR Reid. I would recommend reading this before you post any more smartass comments.

@kevin — you are being very naive to suggest that isn’t what happens already.

When a doctor or nurse “bends the rules” to give care to one patient, they are implicitly reducing the amount of care available to other patients (who at best get over-billed, and at worst are denied care).

There is no free lunch, no matter how much this bothers you and your fellow snowflakes

I am really disappointed that Trump is raising expectations way way too high on everything. I’ve heard his budget director is a really tough conservative who has to be horrified by the way Trump keeps running off at the mouth on how he’s going to make everything great again and it’s not going to really cost very much. He needs to b reminded that we r 20 trillion in the hole so that he needs to listen to the people he’s picked to help him before he makes these outrageous statements!

Geographic restrictions are a myth. Most major insurers are in all markets. But different markets have different issues based on geography. Florida has a high proportion of elderly and a very monopolistic hospital market, so prices tend to be high.

And the barriers to entry are extremely difficult in the insurance market. The major players have consolidated enough that they can afford to take a loss to drive smaller competitors out of the market.

A market driven solution will not work unless pricing is transparent. Now prices are set crazy high, and insurance companies negotiate a much better price. Sounds like racketeering to me. I am surprised that antitrust is rarely discussed with regards to healthcare. Is it a libertarian taboo? Transparent pricing, reimportation of drugs and insurance across state boundaries all seem like obvious fixes, and I believe these were all in Trumps platform, but, of course, they have disappeared.

There will a big problem with grandfathering plans for people with existing conditions. Can hardly let them die, but no sane insurance plan will take them on board?
Other than that, far more has to happen on a cash basis if you want “normal” pricing. In other OECD countries where costs are about half and where there is (sometimes) competition for insurance plans, the insurance companies favor broad coverage over high deductibles. As long as the insurance companies cover most expenses, there is little market effect — the same problem (increasing costs/inflated prices) as in the USA but at less stunning price levels: things will only change when people make the same type of decisions about medical services as they do about tomatoes. Part of the same problem is lack of itemization. Staying a night in the hospital cannot be more expensive than a night in the Ritz Carlton while additionally hiring a private nurse and a hooker: extraneous costs are being included in the hospital bed.

It would be nice if it were that easy. Most of the time you don’t have the time to price shop.

Let’s think about when you actually use healthcare. Typically it’s because you got sick or had an accident.

Let’s say you start having abdominal pain. Severe pain, too bad to sleep. Do you shop around for the hospital with the lowest ER cost? No, you go to the closest. When you get there, they want to do Xrays and a CAT scan. Do you say “stop, I want to get some price quotes?”, no you get the damn scan because you could be dying and you want to be out of pain. They say you have an intestinal blockage and you need immediate surgery. Do you say “bring me my laptop, I need to check prices at the surrounding hospitals and I want to interview some surgeons”. No, you have them save your life.

These free market concepts are great when you’re talking about optional procedures and maybe some annual diagnostics, but for the big things – heart attacks, strokes, accidents, broken bones, cancer, etc they don’t work in the real world.

Have the studies data sent (along with a certified check drawn on a major American bank) to Chelsea over at The Clinton Foundation. They will look into it and find a way to bash Ben Carson over the implications you cite.

The US will go bankrupt because of health care costs. The centers for medicare and medicaid spent $1.417 trillion in fiscal 2016. In fiscal 2015 it was $1.296. The increase is 9.3%. Do you think it is going to get any better under Donald Trump? No. Cost is high because of monopolistic protections from top to bottom. Federal, State, and Local. You want to open an MRI shop? Nope. There is a local organization which is in charge of the best use of medical resources. In other words, it is the local cartel which protects the prices of the existing members of the cartel. If there was competition you would see advertisements for $400 midnight special for an MRI.

$1.417 compounding at 9.3% gives you $2.210 trillion dollars for the year ending September 30, 2021. Raise payroll taxes by $800,000,000 dollars by then? Sure, then we go BK.

Prices have to be reduced by 50%. I mean cost, not subsidized prices like liberals say. Competition needs to return. Single payer is simply rationing.

I disagree that low deductibles are the problem. Improperly designed plans, such as mandated obgyn coverages for single men, requiring insurers to accept preexisting conditions without allowing proper pricing for it, charging younger people more and older people less than actuarially correct, equal premiums for men and women when women consume much more health care dollars, and on and on with decisions made in order for it to be politically acceptable.

Everybody complains about low growth, or worse, in the economy, yet all these schemes like insurances come out of people’s earnings, thus driving down aggregate demand. How clever is that?
The fed can buy all the healthcare we need. After all theres no trouble with subsidies for agriculture, or whatever is favoured at a particular time. Just include medicare.

Congress must act. Our elected representatives in the House and Senate must:

Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.

Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.

Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.

Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

The reforms outlined above will lower healthcare costs for all Americans. They are simply a place to start.

Australia has a mixed private and public system whereby those who can afford private health insurance and those who cannot are covered. The system is paid for by a medicare levy of 2% of taxable income. Most aussies also have private health cover that covers hospital stays and various incidentals. All up we spend around 6.8% of our gdp on health care and have one of the best systems in the world. Always wondered why the US didnt introduce our system.

It would be silly to publish it now and have it picked apart. I think all will be revealed.

It can be AVAILABLE to everyone but not required.

The big problem is ER and catastrophic coverage – we all pay for those who can’t afford it and the “EMTALA” – emergency rooms can’t let people die in the parking lot – isn’t going to be repealed. But if ERs have to treat, someone has to pay, so their rates go up to cover it, so everyone’s insurance goes up.

ERs aren’t part of the market. Lets say you are on vacation and struck by an errant rock that came loose from a cliff and are unconscious. Tell me how you “shop around” for treatment? You will have an ambulance or life flight (thinking glacier national park – or maybe we can have insurance that excludes being away from high population density areas where there is a trauma center every 40 miles – but you’d be uninsured if you went outside). Then the ER WILL treat first, and bill later. Can they bill $10,000,000 for a concussion? They did the service, and you didn’t complain (so what you were dazed).

One reason we can never have a proper discussion of health care and health insurance is we can’t separate emergencies and catastrophic events, chronic conditions, and “I have the sniffles”.

That combined with all the market breakage Obamacare caused (I could have kept my nice catastrophic plan) – where you have to cover birth control (how about not having sex or paying for it yourself?), comprehensive physicals (my country doctor includes this in my monthly fee for the out-of-stupidity direct to doctor plan), mammograms – Mish, have you had your’s yet? etc. and then because you couldn’t keep your old plan and your new plan is likely to blow up, you WILL end up with a preexisting condition and no coverage!

This is a bomb that must be defused, not just blown up taking millions with it.

Has anyone bothered to ask themselves why the US spends about 20% of our GDP on health care while other 1st world nations spend only 10% to 13% of GDP?

WHO reports that the US spends about $8362 per capita on health care. The OECD 1st world nations (to include the US) spends a per capita average of about $4380. PLUS most (if not all) of the other OECD nations have an average per capital life span that exceeds the one in the US.

So we spend about twice as much as the other 1st world nations and die sooner.

Gee, what’s wrong with that picture?

Perhaps we should have an honest conversation why our health care system sucks.

The US is ranked 31. At least 2 years (HALE) behind all other OECD nations. 2 years is a huge statistical difference in life expectancy on a national scale. We fall way short of England’s per capita life span and everyone constantly complains about their lousy government run health care system.

I agree that the US subsidizes global health care that robs the US taxpayer. Hopefully Trump will put a stop to that crap.

@kevinMackay — if what you claim were true (that the US pays for “diversity”)… then you are basically just arguing against immigration.

You are ignoring the waste and fraud caused by the US payment system. You are ignoring over-use of many services.

And you seem rather ignorant about what services other countries actually offer in their “universal” systems. Rich people in those “universal” systems all travel abroad for anything other than primary care treatment — because their universal systems don’t cover anything else, and their domestic systems have poor quality.

The US has been advanced treatment center to the world. We pay the costs, they get a free ride. We make it worse for ourselves with lots of fraud, waste and abuse.

Diversity isn’t the problem. Freeloaders and over-use are the problem.

How do you explain that 90% of pharmacy testing cannot be reproduced (not even in the same hospitals)? Why do two doctors in the same city have vastly different rates of surgery, but essentially the same health outcomes?

A US doctor performing three times as many tonsillectomies as another US doctor does not produce three times better health outcomes (or anything even close). Other countries don’t automatically cover a tonsillectomy just for giggles. This over-use has massive costs.

And then we have the billing fraud that is rampant in private insurance, and mind boggling in medicare. Have you ever looked at a medical bill? Often, doctors are at a loss to explain many of the charges on “legitimate” bills. And in too many situations, billing fraud is deliberate and rampant.

I could fly to India and get a quadruple bypass (plus aftercare) for $25,000 cash (or less) at a 5 star hospital performed by US trained cardio-thoracic surgeons while the same procedure at a US hospital would cost me $200,000 cash (or more).

India’s “universal care” (such as it is) does not cover your surgery… it would still be a great savings (even including airfare).

But if everyone got their surgery in India for less — who would pay for all of Obama’s free loaders, all the billing scams, and the army of medicare bureaucrats? And who would subsidize the unnecessary over-treatments?

US surgery costs more than flying to India, and Obamacare makes it too costly to stay home and ignore the pain. No matter what stupid comments emanate from Obozo after Friday or what stupid comments come out of Congress (who exempted themselves) … Obamacare is doomed by its own stupidity.

For all the cr-p Obama gave them, it was Walmart that introduced $10/month generic drug refills… not the criminals in Washington or any insurance company.

Four more days until Obozo leaves the White House… good riddance to a terrible president

Obama’s departure will be analogous to giving the country an enema. We should see things start to flow smoothly again.

Millions of Americans practiced medical tourism until the government forced them to buy into Obamacare. Some probably pay the penalty and still fly to foreign countries for major surgeries or procedures and still come out ahead financially.

US health care sucks. We pay the most by far and die sooner than all the other 1st world nations.

Unfortunately when you find out you need that quadruple bypass you don’t typically have time to make those arrangements. That’s not the kind of surgery you can schedule weeks or months in advance like a knee replacement.

VA health care gets a bad rap. But most of the problems are isolated to certain regions that are poorly managed. Many of the regions are well managed and the vets get good treatment. Overall the system is pretty efficient and has an exceptional medical data system that’s the envy of many private health care systems. Negative news is more popular than positive news. It sells more papers and gets more hits on the web. I’ve seen reports that rank VA medical outcomes superior to Medicare. Lots of great medical research comes out of the VA system as well.

(1) The locations that get “a bad rap” happen to be places where there are a lot of veterans… aka where the VA is needed most.

(2) The stats are obviously tough to verify, but a disturbingly large percentage of homeless are/were Vietnam veterans…. that the VA hospital system simply forgot about. Tens of thousands of f-ups by the VA administration

(3) Walter Reed was shut down because there was feces on the walls… yep, mentally disturbed patients put the stuff on the walls, but staff failed to clean the walls — or more importantly treat the patients.

(4) the number of veterans who commit suicide is just plain disturbing. As a group, they are not getting mental care.

You will never convince me that VA administrators back in Washington DC deserve six figures for failing this badly. If that many soldiers were dying during training, the media would never let it rest. Generals would be fired, not given raises and promotions like the VA system.

And for all the “progressively stupid” people who voted for Obozo — the VA system is a single payer system run by the US government. You cannot claim this VA neglect is not indicative of what everyone should expect if the US government ran all healthcare.

Not disclosing the details before taking office is smart Washington DC politics… not sure how it plays overall.

If we trust the rubbish coming from WaPo which has a history of getting Trump stories wrong — then supposedly he promised “health insurance” for all. My first inclination is to think the clowns at WaPo almost certainly got the quote wrong, if not the entire story.

But just to humor Mish… insurance is supposed to pool risks, not cover everyday expenses. If everyone had access to catastrophic coverage (essentially a death benefit by another name) — it might be plausible. It would help offset what is currently the most costly part of health care (end of life care).

Primary care benefits, if limited to a specific set, is what colleges offer their students. Its fairly cheap, even for older adults — and doesn’t really cover much. This is what most other countries actually offer in their “universal care” systems (they don’t cover anything close to what US citizens have come to expect).

And then all the other “coverage” becomes optional? Buy your own supplemental coverage, or pay “cash” — either way usage crashes as the hypochondriacs are forced to pay for their own bull sheet.

The UK’s NHS tries to cover the other stuff, but it is failing. Wait times are bad, quality of care is falling — and fiscally speaking NHS cannot survive without royalties from North Sea oil fields. Canada has the same oil royalty dependency (and even worse wait times / quality issues) — ergo Canada’s health minister went to the US for a complex operation. Germany gets massive subsidies from their mercantile export system… which may not survive the collapse of the EU.

No country can afford to offer free unlimited care — not even the Swiss or Persian gulf countries.

The US had a “pay cash” medical system for centuries until FDR messed everything up. It would not be such a bad thing to return to what worked.

Whether this is what Trump has in mind, or will Washington DC embark on yet another fantasy program… that will be interesting. Given the track record, I imagine Washington DC will find a way to screw things up and will go bankrupt — I hope Trump will prove me wrong on this, but seeing the idiots in Congress he has to work with…

‘Improving’ ACA is like BREXIT LOL
The devil is in the details and as it looks right now on both sides of the Atlantic it is amateur hour. I like to see everything in writing=law, before 2017 (or 2018 or 2019 😉 is the year of jubilee

Good health and good outcomes for individuals, not one mention by anybody. Why is that?

A nation of affluent consumption addicts: pills, insurance, you name it. Treatments that are as expensive as possible are good for medical industry profits. Outcomes for individuals are secondary for corporate medical factories churning out “health care.” In medieval times when the church had monasteries with large landholdings producing wealth, medical, food and clothing was part of charity for the poor. Now it is a political football.

The UK used to have the most cost effective health service in the world. The Commonwealth Fund (a US based think tank) analysed the top 11 countries for health care and spend in 2014. The NHS came first with a spend of $3,405 per head of population and the US last with a spend of $8,508 per head. In fact, the US wastes as much money on its insurance companies that administer its healthcare, as is used to fund the entire NHS or $3,405 per head. And yes the NHS used to be government organised. You would of course think that success moves from good to bad but you would be mistaken. Privatisation in the UK is destroying our healthcare. So instead of the US becoming more like the UK, the UK is becoming more like the US. In the hands of the neo-liberals, success breeds failure. And before you deride governments, we would not be communicating with each other had the US government not funded and invented the internet.

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